More about Urinary Tract Infection

A urinary tract infection (UTI) occurs when bacteria multiply in the urethra (the tube through which urine flows from the bladder to the outside of the body), in the bladder itself, or in the kidneys, disrupting normal function and causing swelling and infection.

Infection of the bladder or lower urinary tract is called cystitis. Urethritis is an inflammation of the urethra. Cystitis and urethritis usually occur together.

In some cases women with painful urination have an infection of the upper urinary tract, which can be difficult to distinguish from a lower urinary tract infection. Upper urinary tract infections can spread into the kidneya condition called pyelonephritis, which may be accompanied by back pain, chills, fever, nausea, and/or vomiting.

Many women suffer from frequent UTIs, with nearly 20 percent of women who have one UTI also having a second. UTIs are the second most common cause of physician visits each year, after respiratory infections such as pneumonia and bronchitis; approximately eight million women go to their doctors annually with UTI complaints.

Although men can develop UTIs, they are rarer, with infection typically associated with a urinary stone or an enlarged prostate. Women are more susceptible than men to UTIs because the urethral opening in women is close to the anus, where bacteria thrive, and because the female urethra is much shorter than a man’s, allowing bacteria quicker access to the bladder.

Symptoms of Urinary Tract Infection

Not everyone with a urinary tract infection will have symptoms, but most people will experience some of the following.

Frequent urge to urinate

A painful burning feeling in the bladder or urethra during urination

Despite an urge to urinate, ability to pass only a small amount of strong-smelling, cloudy, sometimes blood-tinged urine

What Causes Urinary Tract Infection?

Ordinarily, the flow of urine helps wash away bacteria often present in the urethra and bladder. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. Despite these safeguards, however, infections still occur.

Most UTIs in women are caused by by the E. coli bacteria, which live in the colon and can be easily spread from the rectum to the urethra. Often this occurs during sexual intercourse, which can push bacteria from the anal area up toward the vagina and into the opening of the urethra; from there they travel into the bladder. Young women who are becoming sexually active for the first time are especially susceptible. Bacteria other than E. coli as well as sexually transmitted organisms can also cause infections in both men and women.

Pregnancy also increases the risk of UTIs because as a fetus grows, the bladder becomes compressed and doesn’t empty completely, allowing bacteria to reproduce. Diaphragms used for birth control compress the urethra, making infection more likely.

Perimenopausal and postmenopausal women are also susceptible owing to a decrease in estrogen production, which causes tissues in the urinary tract to thin out and become more easily inflamed.

Some cases of recurring UTIs are due to structural abnormalities that impede the flow of urine, and often correction by surgery is needed to halt the infections.

What If You Do Nothing?

Mild cases of cystitis and urethritis can often clear up without treatment. But if symptoms last longer than two days, you should consult a doctor, since some untreated UTIs may turn into kidney infections, which can be serious and much harder to cure.

Home Remedies for Urinary Tract Infection

Only women who have had uncomplicated recurring UTIs should consider self-treatment, which will still usually require a supply of antibiotics obtained from a doctor. Before supplying you with antibiotics, your doctor should carry out a thorough evaluation.

The following measures may also help recovery during a bout of cystitis.

Use pain relievers. To alleviate cramps or stomach pain, take over-the-counter pain relievers—NSAIDs (such as aspirin, ibuprofen, and naproxen) or acetaminophen—according to label directions.

Try applying heat. A warm heating pad (on a low setting) or a hot water bottle placed on your lower abdomen may help soothe pain.

Drink fluids. Drink 10 to 14 glasses of water a day to help increase urine flow and flush out the substances causing the problem.

Drink cranberry juice. The juice seems to possess something that keeps bacterial organisms from attaching to the walls of the bladder and urethra, and thereby prevents them from multiplying. Researchers have suggested that cranberry juice might be used as an adjunct to medical treatment—though not as a substitute for it. (Capsules containing cranberry extract may help—one small study supports this. However, no one knows what the right dose is, and you can’t even be sure the capsules contain what the label indicates.)

A Home Test That Works

Testing for a urinary tract infection (UTI) meant a visit to the doctor. But if you’re one of the millions prone to recurrent UTIs, there are several home tests that might save you an office visit.

The UTI home testing kit, approved by the FDA and available in drug stores ($6 to $9), consists of six dipsticks and six small plastic urine cups, plus instructions. You test the first morning urine; if results are positive, you can call your nurse practitioner or physician and ask for a prescription. Of course, you may be asked to come in for an exam and further testing, but if you’re having a recurrence, the test may save time and money. The test will pick up 80 to 90 percent of infections.

This is one test where “negative” results are not good news. Painful urination and other common symptoms of UTIs may actually be caused by a sexually transmitted disease. If the test results are negative and your symptoms persist, you should certainly get a medical evaluation.

Prevention

Drink plenty of fluids. Drink at least eight glasses of liquid a day—enough so that you urinate at least once every four or five hours.

Include cranberry juice. People have been drinking cranberry juice for years to prevent UTIs—and some research supports this. Studies have shown that it helps keep the bacteria in the urinary tract from settling in. A Harvard study found that women who drank 10 ounces of cranberry juice daily significantly reduced infection rates over a six-month period.

Don’t delay using the bathroom. Delayed urination is a major cause of UTIs. Emptying bacteria-laden urine from the bladder helps reduce the bacteria count.

Practice bathroom hygiene. Wipe from front to back to prevent bacteria around the anus from entering the urethra or vagina.

Cleanse the genital area before sexual intercourse. Also, urinate immediately after sexual intercourse.

Consider changing your birth control method. Women who use spermicides containing nonoxynol-9 are often at higher risk for UTIs because it changes the bacterial balance in the vagina, allowing E. coli to proliferate. The use of a diaphragm may also promote UTIs. Consider switching to oral contraceptives.

Avoid using feminine hygiene sprays and scented douches. These products can irritate the urinary tract.

If you’re past menopause, use a water-soluble vaginal lubricant. Vaginal tissues are drier after menopause, and may be more easily irritated and thus infected during sexual intercourse. A vaginal lubricant will help prevent this.

Avoid using bathtubs; use shower instead.

Avoid artificial sweeteners.

Beyond Home Remedies: When To Call Your Doctor

Anyone who is experiencing symptoms for the first time should contact a doctor. Also call your doctor if you are self-treating a recurrent UTI with antibiotics (on your doctor’s advice) and symptoms persist for a day or two, or if you develop new symptoms. Call your doctor right away if urinary discomfort is accompanied by fever, chills, or back pain, indicating a possible kidney infection.

What Your Doctor Will Do

After taking your history and reviewing your symptoms, the doctor will do a complete urinalysis and take a urine culture. Specific antibiotics are usually prescribed to fight the infection; often a three- to five-day regimen is sufficient.

If a woman has three or more UTIs in a year, her doctor may recommend low-dose, long-term antibiotic therapy.

If you repeatedly have attacks of cystitis after sexual activity, your doctor may recommend that you take a single dose of antibiotic right after sex. A single dose can be enough to kill bacteria that have just entered the bladder.